AUA, ASTRO team up for post-RP RT guideline

The AUA and the American Society for Radiation Oncology (ASTRO) have released a joint guideline on radiation therapy after prostatectomy for patients with and without evidence of prostate cancer recurrence.

The Adjuvant and Salvage Radiotherapy After Prostatectomy: ASTRO/AUA Guideline is a comprehensive review of 324 research articles of English-language publications published from Jan. 1, 1990 through Dec. 15, 2012. The guideline is available online free of charge as a PDF document at www.redjournal.org and www.auanet.org, and will be published in the Aug. 1, 2013, issue of the International Journal of Radiation Oncology • Biology • Physics, and in the August 2013 issue of the Journal of Urology.

The strategies and approaches recommended were derived from evidence-based and consensus-based processes in the reviewed articles. The systematic review included articles that provided detailed efficacy in patients with detectable and undetectable PSA levels, toxicity and quality of life impact, and optimal imaging strategies to determine the appropriateness of radiation therapy use in patients suspected of recurrence. Only studies in which PSA data were provided for 75% or more patients were included in the guideline.

The guideline document includes the following clinical principles, recommendations, standards, and options:

Patients who are being considered for management of localized prostate cancer with radical prostatectomy should be informed of the potential for adverse pathologic findings that portend a higher risk of cancer recurrence (clinical principle)

Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at the time of prostatectomy, including seminal vesicle invasion, positive surgical margins, or extraprostatic extension because of demonstrated reductions in biochemical recurrence, local recurrence, and clinical progression (standard, evidence strength: grade A).

Patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of development of metastatic prostate cancer or death from the disease (clinical principle).

A restaging evaluation in the patient with a PSA recurrence may be considered (option, evidence strength: grade C).

Physicians should offer salvage radiation therapy to patients with PSA or local recurrence after radical prostatectomy in whom there is no evidence of distant metastatic disease (recommendation, evidence strength: grade C).

The 81-page guideline represents a collaboration among experts in the radiation oncology and urology fields, led by Richard K. Valicenti, MD, MA, of the University of California Davis Comprehensive Cancer Center in Sacramento, on behalf of ASTRO, and Ian M. Thompson, MD, of the University of Texas Health Science Center at San Antonio, on behalf of the AUA.

“The work of the AUA and ASTRO staff, as well as our exceptional guideline panelists, was outstanding,” said Dr. Thompson. “This guideline provides a very practical approach for the clinician to help guide in patient decision-making that will result in the very best patient outcomes.”